Provider Demographics
NPI:1184497802
Name:RODRIGUEZ, ROLDAN JR (PD AGRNA, CHN, INHC)
Entity type:Individual
Prefix:
First Name:ROLDAN
Middle Name:
Last Name:RODRIGUEZ
Suffix:JR
Gender:M
Credentials:PD AGRNA, CHN, INHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8605 SANTA MONICA BLVD # 368151
Mailing Address - Street 2:
Mailing Address - City:WEST HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90069-4109
Mailing Address - Country:US
Mailing Address - Phone:323-383-8288
Mailing Address - Fax:
Practice Address - Street 1:72809 SONORA DRIVE
Practice Address - Street 2:
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92260
Practice Address - Country:US
Practice Address - Phone:323-383-8288
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-03
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA171400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach